Evaluating the value of robotic versus open pancreaticoduodenectomy: improved clinical outcomes without compromising hospital revenue per admission.

PURPOSE: Robotic pancreaticoduodenectomy has been increasingly adopted; however, its economic feasibility under the Japanese national health insurance system remains unclear. This study aimed to evaluate the clinical and economic outcomes of robotic pancreaticoduodenectomy (RPD) compared with open pancreaticoduodenectomy (OPD). METHODS: Patients who underwent pancreaticoduodenectomy between January 2020 and December 2024 at The University of Tokyo were identified from an institutional database. Patients with pancreatic ductal adenocarcinoma were excluded because portal vein resection and reconstruction performed on a robotic platform were not covered by the Japanese National Health Insurance System during the study period. The clinical outcomes and economic indicators, including hospital revenue, costs, and profit, were assessed under the Japanese lump-sum payment system. RESULTS: Eighty-three patients were included in the study (41 in the robotic group and 42 in the open group). The rate of clinically relevant pancreatic fistula was significantly lower (2.4% vs. 45.2%, P < 0.001), and the median hospital stay was significantly shorter (7.0 vs. 22.5 days, P < 0.001) in the robotic group. The mean hospital revenue per admission (22,007 vs. 19,701 USD, P = 0.015) and profit per day (2,552 vs. 793 USD, P < 0.001) were significantly higher in the robotic group. CONCLUSIONS: Robotic pancreaticoduodenectomy yielded superior perioperative outcomes and shorter hospitalization than open pancreaticoduodenectomy in selected patients without compromising hospital revenue per admission.